| NPI | 1760450571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 35553) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 10946) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-07-24 |